Key messages

  • Candida auris (also called C. auris) is an uncommon fungus that can cause serious infections.
  • In most cases patients who carry the fungus on their body do not get sick from it, but it can sometimes lead to serious bloodstream, wound and ear infections.
  • C. auris can also cause problems in hospitals and nursing homes as it can spread from one patient to another or from nearby objects.
  • C. auris is also often resistant to medicines, making it very difficult to treat.
  • C. auris can be difficult to identify in laboratories without specialised testing equipment

Notification requirements for Candida auris infection

C. auris infection or colonisation is not a notifiable condition under the Public Health and Wellbeing Act (2009). 

However, given the public health significance of this disease it is currently requested that all confirmed or probable cases (invasive infection or colonisation) are notified by the treating clinician, by telephone, to the Department of Health and Human Services via 1300 651 160. 

Additionally it is requested that all isolates of confirmed C. auris are forwarded to the Victorian Infectious Diseases Reference Laboratory for further confirmatory and susceptibility testing. 

Infectious agent of Candida auris infection

C. auris is a fungal infection (also known as yeast infection) which is part of the Candida species.  It is an uncommon fungus, but can cause serious infections. The most common type of Candida infection is Candida albicans, which commonly causes thrush.  

Identification of Candida auris

Clinical features

Colonisation with C. auris is asymptomatic. Colonisation is generally on the skin, in the urine or around other indwelling devices (such as PEG tubes and central lines). 

Invasive infection can present as sepsis, urinary tract infections, wound infections, ear infections or line infections. C. auris sepsis has a case fatality rate between 30 per cent and 60 per cent, similar to other invasive Candida infections. Most people with invasive infection have other co-morbidities. 

The types of infections caused by C. auris are no different from those caused by other types of Candida, however, C. auris is of particular concern as it can be more difficult to treat than other Candida infections. It can also spread more easily to other patients.

Diagnosis

Laboratory diagnosis via culture is the only way to diagnose C. auris infection or colonisation.

Clinicians and laboratories should be aware of the possibility of C. auris, especially in high-risk patients who have cultured non-albicans Candida species. Any confirmed isolates of C. auris should be forwarded to the Victorian Infectious Diseases Reference Laboratory for further confirmation and typing.

Public Health significance of Candida auris infection and colonisation

C. auris is a major public health concern for the following reasons:

  • It causes serious infections. C. auris can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems. More than one in three patients with invasive C. auris infection (for example, an infection that affects the blood, heart, or brain) die.
  • It’s often resistant to medicines. Antifungal medicines commonly used to treat Candida infections often don’t work for C. auris. Some C. auris infections have been resistant to all three types of antifungal medicines.
  • It’s becoming more common. Although C. auris was just discovered in 2009, it has spread quickly and caused infections or facility outbreaks in more than a dozen countries.
  • It’s difficult to identify. C. auris can be misidentified as other types of fungi unless specialized laboratory technology is used. This misidentification might lead to a patient getting the wrong treatment.
  • It can spread in hospitals and nursing homes. C. auris has caused outbreaks in overseas healthcare facilities and can spread through contact with affected patients and contaminated surfaces or equipment. Good hand hygiene and cleaning in healthcare facilities is essential because C. auris can live on surfaces for several weeks. 

Mode of transmission of Candida auris

C. auris can spread in healthcare settings through contact with contaminated environmental surfaces or equipment, or from person to person. More work is needed to further understand how it spreads. 

Period of communicability of Candida auris

People who are colonised or who have had an infection with C. auris are considered to be colonised indefinitely at this point, and must remain in contact precautions for all hospital admissions. Further research is required before clearance criteria can be determined.

Candida auris in Australia: Who is at risk?

International travel to affected areas (such as the UK, India, Pakistan, China, South Africa and parts of the USA) creates an increased risk of spread of C. auris to Australia. Admission to healthcare services or residential care in these areas is a particularly significant risk factor for C. auris colonisation.

It is important to know that people may carry C. auris on their skin without any symptoms; these individuals are at risk of getting C. auris infection if they are hospitalised for another reason. C. auris is more likely to affect patients who have:

  • A hospital stay in an area with documented or suspected C. auris transmission
  • A prolonged hospital stay
  • An indwelling medical device, such as a central venous catheter, urinary catheter, biliary catheter or wound drain
  • An impaired immune system
  • Multiple or recent exposures to broad spectrum antibiotics
  • Diabetes mellitus
  • Recent surgery

Australia has had very few identified cases of C. auris to date. This is due in part to our geographic isolation; however, the risk of C. auris spreading to Australia is significant enough that it is recognised as an emerging and high risk public health issue.

Control measures for C. auris in health care

Control of cases

Infection control precautions for patients with C. auris, that is, single room and contact precautions, must be instituted every time they are admitted to a health care facility and maintained until discharge (even if screening specimens taken at the time are negative for C. auris). Until further evidence to the contrary is available, the current advice for the use of infection control precautions is that once a person is identified as a case of C. auris, they should be considered potentially infectious indefinitely.

If you are referring a patient with known C. auris (infection or carriage) to hospital, including outpatients/consultant rooms or the Emergency Department, please make sure you inform the hospital

Control of contacts

Early detection of C. auris through targeted patient screening is essential to enable containment. Therefore, as cases are detected in Victoria there will be targeted contact tracing exercises undertaken in patients who may have been in contact with the case during hospital admissions.

The use of standard and contact precautions, including effective hand hygiene, reduces the risk of transmission between patients.

Infection prevention and control measures, as well as isolation or patient cohorting measures are of proven value for limiting the spread and impact of C. auris in healthcare settings, as well as for controlling outbreaks.

Outbreak measures for Candida auris

Given the low case numbers in Australia and the public health significance of the organism, every identified case is considered an outbreak.

Swift case and contact control actions must be undertaken for each case as described above.

Further information

For further information for clinicians, health care facility staff, patients and visitors and screening:

Additional information is available here:

Contacts

For more information please contact the Communicable Disease Prevention and Control section at the Department of Health and Human Services on 1300 651 160.